The Care Quality Commission
  • Care Home
  • Care home

Archived: Milton House

Overall: Good read more about inspection ratings

West Street, Bridgwater, Somerset, TA6 3RH (01278) 422235

Provided and run by:
Somerset Care Limited

Important: This service is now registered at a different address - see new profile

All Inspections

21 October 2014

During a routine inspection

Milton House is a care home which is registered to provide care for up to 51 people. The home specialises in the care of older people who require general nursing care. There is a registered manager who is responsible for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At the last inspection carried out on 22 October 2013 we did not identify any concerns with the care provided to people who lived at the home.

This inspection took place on 21 October 2014. This was an unannounced inspection which meant the staff and provider did not know we would be visiting.

Throughout our inspection we observed staff interactions were kind and respectful. There was a cheerful atmosphere in the home and people appeared relaxed and comfortable with the staff that supported them. One person told us “we have such a laugh. They know my sense of humour. We do have a giggle.” Another person said “I’d give them top marks. All the staff here are fantastic. They always have a smile and that’s saying something; it’s not an easy job.”

Staff knew what was important to people and they spoke about people in a caring and compassionate manner. For example, one member of staff said “I treat everyone like they were a member of my family. You have to be aware of the things that are important to people.” A visitor told us “all the staff are so kind and thoughtful. My [relative] has always liked her clothes and jewellery to be coordinated. It is something that is important to her and all the staff know that.”

People told us they felt respected by the staff who supported them. Comments included “they always knock on my door before they come in and if I just want to be by myself, they respect that” and “I need help to have a bath. When I first moved here I felt awkward about someone helping me, but the staff are lovely and I soon felt at ease.”

Care plans contained clear information about people’s assessed needs and preferences and how these should be met by staff. This information enabled staff to provide personalised care to people. Care plans had been regularly reviewed to ensure they reflected people’s current needs.

People could see appropriate professionals such as GPs, dentists, district nurses and speech and language therapists. People said staff made sure they saw the relevant professional if they were unwell. One person said “If you say you feel unwell, the nurses are there and they will get the doctor straight away.” Another person told us “I will be seeing the dentist soon as my dentures feel a bit loose.”

People received their medicines when they needed them. There were procedures in place for the safe management and administration of people’s medicines and we saw these were followed by staff. One person we spoke with said “I see the nurse every day. They bring me my tablets three times a day. They never forget me.” Another person told us “Sometimes I need my pain killers. I just need to ask and they bring them straight away.”

People were supported to maintain contact with friends and family. Visitors we spoke with said they were able to visit at any time and were always made welcome. People were supported to be involved in the local community and the home took part in community activities. For example children from a local school regularly visited the home and one person told us staff had taken them to a local fair the previous week.  

Systems were in place which ensured people’s wishes and preferences during their final days and following death, were respected. The home had recently achieved reaccreditation to the ‘National Gold Standard Framework.’ This is a comprehensive quality assurance system which enables care homes to provide quality care to people nearing the end of their life.

People lived in an environment which was safe and well maintained. Regular checks on lifting equipment and the fire detection system were undertaken to make sure they remained safe. Hot water outlets were regularly checked to ensure temperatures remained within safe limits. There was an emergency plan in place to appropriately support people if the home needed to be evacuated.

Staff received training which enabled them to deliver effective care and support. We spoke with staff and viewed training records. We saw staff had good opportunities for on-going training and for obtaining additional qualifications.  A number of staff had attained a National Vocational Qualification (NVQ) in care or a Diploma in Health and Social Care. There was a programme to make sure staff training was kept up to date. Staff had also received training in how to care for people with a dementia.

Staff were up to date with current guidance about how to support people to make decisions  and to keep them safe. 

The people we spoke with told us they would feel comfortable about raising concerns if they had any. Comments included “I could tell any member of staff if I wasn’t happy about something and it would be sorted out.” Another person said “they wouldn’t want you to be unhappy. They would want you to say if you had any worries.” The visitors we spoke with told us they found the registered manager and staff approachable and would not hesitate in bringing any concerns to their attention.

There was an open and transparent ethos within the home. The registered manager told us they were committed to providing high standards of care. This ethos had been adopted by the staff we spoke with and observed. We observed staff morale was very good. Staff made the following comments “I love working here. I wouldn’t want to work anywhere else” and “It is such a happy home. We all work really well as a team.”

There were effective quality assurance systems in place to monitor care and plan on-going improvements. There were audits and checks in place to monitor safety and quality of care.

22 October 2013

During a routine inspection

We spoke with three people who used the service, one relative, three members of staff and a nurse. There were 46 people in residence on the day of our visit.

Everyone asked said that they were happy with the care that they received. Comments included "They look after you very well", "staff are very good", 'staff help' and "staff give people choice, they try to encourage them'.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People told us they were able to choose what times they got up and went to bed and what support the care staff provided. Comments included 'it's my home, I can do what I want' and 'staff will come back later if I ask them'.

People told us that staff were 'kind and gentle' when they assisted with personal care. We observed that people appeared clean and well-presented which demonstrated that staff took time to assist people with washing and dressing.

There were some organised activities in the home to provide mental and social stimulation. Activities included ten pin bowling, bingo, singing and dancing and craft. Two people said that they prefered to stay in their own rooms and didn't want to take part in provided activities and one person said they enjoyed having their hair done. We observed a game of Connect 4 taking place on the day of our visit.

29 January 2013

During a routine inspection

There were 50 people living in the home at the time of the inspection. During our visit we spoke with ten people and seven visitors to the home.

People who lived there were very positive about the service and told us they were treated with respect. Every person we met spoke well of Milton House. One person said "I find things exceptionally good here" whilst another person said 'the staff are very kind to me.'

People told us that staff treated them as individuals and made the changes to their daily routines when they requested it. One person said 'staff help me when I need it.' We were told by another person 'I'm fine in my room I have my call bell if I need anything.'

People told us they had good relationships with the staff and said they "felt safe" at the home and were able to talk to staff if they had any worries or concerns.

The home was accredited to the 'National Gold Standard Framework.' This is a comprehensive quality assurance system which enables care homes to provide quality care to people nearing the end of their life.

People who lived at the home said that they would be comfortable to talk with a member of staff if they were unhappy about the care they received. One person said 'I can speak to the nurse, there's no need to worry.'

The environment was well cared for with important information located in communal areas. We observed all areas of the home were clean and attractive. One visitor commented 'it's clean, doesn't smell, wonderful.'

12 July 2011

During a routine inspection

People spoken with confirmed that they felt involved in decisions about the care and support they received. People said; 'I know I have a care plan and the staff did talk to me about what help I needed', 'I feel the staff here know me very well'. They also said; 'I feel very well cared for here'. A visitor spoken with told us that they communicated with staff on a daily basis about the care their relative received.

Those who were able confirmed that they were supported to make decisions about their lives and how they spent their day. They said; 'they don't mind at all if you want to stay in your bedroom and you can have your meals brought up if you like', 'I told the staff that I didn't like to get up too late and now they help me get up at around seven in the morning which really suits me'.

During our visit we observed staff interactions with people using the service. These were noted to be kind and respectful. People spoken with during our visit told us; 'I feel safe and well cared for here', 'I made the decision to come here and I am very happy with the care I receive'.

During our visit we asked people about the meals available at the home and each person spoken with was very positive about the food and choices available. They said: 'You always have a choice and they know about all the things I don't like', 'You get drinks all day long and they always put fresh water in your room everyday'.

People spoken with during our visit told us that they would feel comfortable in raising concerns if they had any. One person said; 'I know they would do something about it if I had any worries'. Staff spoken with during our visit knew what to do if a person using the service or a visitor raised concerns about the care they received or the service provision.

The home ensures that people have access to appropriate health care professionals and information about people's assessed needs and prescribed medication is readily available when required, for instance when a person requires admission to hospital which helps to ensure that people receive safe and coordinated care. The home has recently achieved accreditation in the Gold Standards Framework. This framework enables a high standard of care for all people nearing the end of life.

We saw that systems were in place to ensure that people using the service always had sufficient supplies of their prescribed medicines. One person using the service said; 'I have to have my painkillers four times a day and the nurses always make sure I get them on time'.

Information about people's assessed needs and prescribed medication was seen to be documented in their individual plan of care.

We spoke with the nurse in charge who confirmed that medicines are only administered by registered nurses.

Each person using the service has their own bedroom which they can personalise with their own possessions. Accommodation is arranged over two floors with a shaft lift providing access to the first floor. Sitting rooms are available on each floor and a large dining area is situated on the ground floor. People with all levels of mobility have access to lovely garden areas.

A call bell system is installed throughout the home so that people can call staff for assistance as required. People told us that staff responded promptly to call bells. One person using the service said; 'my call bell is always answered within a few minutes'. During our visit we saw that people had easy access to their call bells and we observed staff responding to call bells in a timely manner.

Mobile and fixed hoists are available to assist people with their mobility needs and people have access to appropriate numbers of assisted bathing and toilet facilities. We were able to see evidence that all equipment had been regularly serviced by outside contractors. The registered manager and staff spoken with during our visit told us that there was a 'good supply' of specialised equipment. During our visit we saw that appropriate pressure relieving was in place which was in line with individual's assessed needs. We were informed that there was nobody currently being treated for a pressure sore.

We were able to see that people had access to 'specialised' chairs, including wheelchairs. On the day of our visit, one person was being assessed for a specialised wheelchair. Concerns were expressed by staff over the length of time it took for an individual to be assessed following a referral by the home. This will continue to be monitored by the home.

During our visit we viewed all communal areas and a selection of bedrooms and we found the standard of cleanliness to be good with no malodours.

We were able to see that staff had access to a good supply of protective equipment such as gloves and aprons and that these were being used appropriately as 'single use'. Hand sanitising gel and information about reducing the risk of cross infection was seen to be available for visitors in the reception area of the home. Liquid soap, paper towels and hand sanitising gels are appropriately sited throughout the home. This minimises the risk of cross infection and of the spread of infection.

We were informed that the home has a 'stable' staff team and that agency use is 'low' and has only been required to cover registered nurses. We spoke with a number of staff during our visit and all were very positive about the training opportunities available to them. They said; 'the training is excellent' and 'we are always training'. They also confirmed that they were never asked to carry out any task or intervention that they had not received training for.

During our visit, a good staff presence was noted throughout the home. Staff, whilst busy, did not appear rushed. Staff spoken with confirmed that staffing levels were 'safe' and that they were able to meet people's assessed needs.

Each person spoken with during our visit commented on the kindness of the staff team. A visitor told us that the staff were 'polite and respectful'.

Staff working at the home told us that they received regular one to one supervisions and that they were able to discuss any training needs or requests. The registered nurse on duty and all care staff spoken with confirmed that they had received up to date mandatory training and other specialised training.

Staff spoken with during our visit were aware of local safeguarding procedures and of how to report abuse. Those spoken with were aware of people's rights and of what constituted abuse. Staff also demonstrated a good understanding of the Mental Capacity Act and deprivation of liberty safeguards and they knew what action to take if there were any concerns about a person's capacity to make decisions.

We examined a range of records during our visit and all were found to be well maintained and up to date. We saw that all records pertaining to people using the service had been securely stored to ensure confidentiality. All staff working at the home are required to sign a code of conduct and confidentiality policy.